List of Videos. Video 1.1

Transcription

1 Video 1.1 Video 1.2 Video 1.3 Video 1.4 Video 1.5 Video 1.6 Video 1.7 Video 1.8 The parasternal long-axis view of the left ventricle shows the left ventricular inflow and outflow tract. The left atrium is displayed behind the aorta The sweep in the parasternal long axis starts with the long-axis view of the left ventricle. Rightward tilt of the transducer reveals the long-axis view of the right ventricular inlet displaying first the coronary sinus in longitudinal section and then the tricuspid valve. At the end of the video clip, the transducer is tilted back to the long-axis view of the left ventricle The parasternal long-axis view of the right ventricular inlet displays the tricuspid valve and the orifice of the coronary sinus The sweep in the parasternal long axis starts with the long-axis view of the left ventricle. Leftward tilt of the transducer brings into view the long-axis view of the right ventricular outlet displaying the pulmonary valve and the longitudinal view of the main pulmonary artery The parasternal short-axis view of the right ventricular outflow tract shows a normal pulmonary valve with normal separation of the valve leaflets Colour Doppler in the parasternal short-axis view of the right ventricular outflow tract confirms unobstructed flow from the right ventricle to the main pulmonary artery The parasternal short-axis view at the base of the heart displays the aortic valve in cross section. The right ventricle is displayed anterior to the aorta with its transition to the outflow and main pulmonary artery that is displayed to the left of the aorta This parasternal short axis shows the plane of the left ventricular outflow tract just below the aortic valve. Note the transition of the anterior mitral valve leaflet to the posterior wall of the aortic root Video 1.9 The parasternal short-axis view at the level of the mitral valve displays the anterior and posterior mitral valve leaflet presenting with a fish mouth appearance Video 1.10 The parasternal short-axis view at the level of the papillary muscles displays the anterolateral papillary muscle of the mitral valve at 3 o clock and the posteromedial papillary at 8 o clock Video 1.11 Colour Doppler in the high parasternal shortaxis view (in a plane which is cranial to the base of the heart) shows the left atrium and the pulmonary veins (same patient as in Video 1.12) Video 1.12 Slight cranial tilt of the transducer shows the pulmonary bifurcation with unobstructed antegrade flow to both pulmonary arteries displayed in blue (same patient as in Video 1.11). The aorta is displayed in cross section to the right of the pulmonary artery Video 1.13 The standard apical four-chamber view shows both ventricles and both atria. The right ventricle is characterized by septal insertion of the tricuspid valve that is closer to the apex than the mitral insertion. The right ventricular apex can be recognized by the septoparietal moderator band; furthermore, the right ventricular apex is more trabeculated than the left Video 1.14 Video 1.15 The posterior plane of the apical four-chamber view shows the inferior part of the muscular ventricular septum and the coronary sinus, which courses from left to right in the atrioventricular groove to reach the right atrium Colour Doppler in the anterior plane of the apical four-chamber view displays the left ventricle and ventricular outflow tract showing systolic flow from the left ventricle to the aorta coded in blue colour. Diastolic inflow from the left atrium to the left ventricle is coded in red colour Springer International Publishing Switzerland 2017 M. Hofbeck et al., Doppler Echocardiography in Infancy and Childhood, DOI /

2 414 Video 1.16 The cross section of the great vessels in the upper abdomen in a patient with normal situs (situs solitus) shows the inferior vena cava to the right and the pulsating abdominal aorta to the left of the spine Video 1.17 The sweep in a young infant shows the different subcostal coronal (long axis) views. It starts in a posterior view of the atria and the atrial septum. Anterior tilt of the transducer brings into view the left ventricular inflow and the left ventricular outflow tract, the aortic valve and the aorta. Further anterior tilt finally displays the right ventricular outflow tract and Video 1.18 pulmonary valve The posterior plane of the subcostal coronal view shows the upper pulmonary veins draining in the left atrium, the atrial septum and the mitral valve Video 1.19 The anterior plane of the subcostal coronal view displays the right ventricular outflow tract and parts of the ventricular septum. The pulmonary valve can be seen at the cranial end of the right ventricular outflow tract Video 1.20 Colour Doppler in the anterior plane of the subcostal coronal view shows normal flow in the right ventricular outflow tract excluding subvalvular pulmonary stenosis Video 1.21 The sweep in the subcostal short-axis (sagittal) view shows the different planes which can be obtained from right to left. It starts with the short-axis view of the right atrium showing the superior and inferior vena cava entering the right atrium. Leftward sweep of the transducer displays the right ventricular outflow tract and the main pulmonary artery; further leftward tilt of the transducer shows the cross section of the left ventricle Video 1.22 The subcostal short-axis view of the right atrium shows the caval veins entering the right atrium as well as cranial parts of the atrial septum. The right pulmonary artery is displayed in cross section behind the superior vena cava Video 1.23 The subcostal short-axis view of the right ventricular outflow tract displays the outflow tract, pulmonary valve and main pulmonary artery Video 1.24 The most leftward of the subcostal short-axis views displays the cross section of the midportion and apex of the left ventricle Video 1.25 Colour Doppler in the suprasternal short-axis view displays the innominate vein connecting to the superior vena cava, while the aorta is shown in cross section. The right pulmonary artery displayed in longitudinal section behind the aorta Video 2.4 Video 2.5 Video 2.6 Video 1.26 This high parasternal short-axis sweep in a patient with normal cardiovascular connections shows evaluation of the laterality of the aortic arch. It starts with the parasternal shortaxis view of the pulmonary artery bifurcation, displaying the ascending aorta in cross section to the right of the pulmonary artery. Cranial tilt of the transducer shows the transverse aortic arch, the superior vena cava in cross section and the innominate vein in longitudinal section. Further cranial tilt displays the origin of the innominate artery from the aorta to the right. Following clockwise rotation of the transducer combined with some more cranial tilt, the innominate artery is depicted in longitudinal section revealing its bifurcation into the right subclavian and right carotid artery Video 1.27 Colour Doppler in the high parasternal shortaxis sweep shows evaluation of laterality in a patient with normal left aortic arch in analogy to Video 1.26 Video 1.28 Suprasternal long-axis view of the aortic arch depicting origin of the left common carotid and left subclavian artery from the aortic arch. The innominate artery is not well displayed; its origin is in close proximity to the innominate vein, which is displayed in cross section anterior to the ascending aorta Video 1.29 Colour Doppler in the suprasternal long-axis view of the aortic arch (same patient as in Video 1.28) shows laminar flow in the ascending and descending aorta. The vessel displayed in cross section posterior to the ascending aorta is the right pulmonary artery Video 2.1 Parasternal short-axis view at the level of the aortic valve showing a secundum ASD behind the aortic root Video 2.2 Colour Doppler in the parasternal short-axis view of the aortic valve showing left to right shunting across a secundum ASD Video 2.3 Subcostal short-axis view showing a mediumsize secundum atrial septal defect Colour Doppler in the subcostal coronal view shows significant left to right shunting across two secundum atrial septal defects The subcostal short-axis view of the atria shows a patent foramen ovale with overlap of the septum primum and septum secundum Colour Doppler in the subcostal short-axis view of the atria (same view as in Video 2.5) shows minimal left to right shunting across the patent foramen ovale

3 Video 2.7 Video 2.8 In a patient with sinus venosus ASD, the subcostal short-axis view displays the connection between left and right atria just underneath the superior vena cava Counterclockwise rotation of the transducer towards the subcostal long-axis view (same patient as in Video 2.7) elongates the atrial septum and demonstrates overriding of the superior vena cava over the large sinus venosus defect Video 2.9 Colour Doppler in the subcostal short-axis view (same patient with sinus venosus ASD as in Videos 2.7 and 2.8) shows mixing of flow from the superior vena cava and the ASD Video 2.10 Following interventional occlusion of a secundum ASD, the apical four-chamber view shows correct position of the double-disc device of an Amplatzer R septal occluder Video 2.11 Video 2.12 Video 2.13 Apical four-chamber view following occlusion of a secundum ASD with a Gore R septal occluder Following interventional occlusion of a secundum ASD, the subcostal short-axis view of the atria shows the double-disc device of an Amplatzer R septal occluder in the area of the fossa ovalis Following interventional occlusion of a secundum with a Gore R septal occluder, the subcostal short-axis view of the atria shows the device in the area of the fossa ovalis Video 2.14 Colour Doppler in the apical four-chamber view reveals significant LR-shunting across a medium-size secundum ASD Video 2.15 Video 3.1 Video 3.2 Video 3.3 Video 3.4 Video 3.5 Colour Doppler of the atrial septum in the subcostal coronal view reveals RL-shunting across a stretched foramen ovale in a patient with pulmonary atresia and intact ventricular septum Large perimembranous VSD in the parasternal short-axis view. The defect is located in close proximity to the tricuspid valve and aortic valve Colour Doppler in the parasternal short-axis view displays significant LR-shunting across this large defect (same patient as in Video 3.1) The apical five-chamber view in an infant shows a perimembranous VSD which is located just underneath the aortic valve Colour Doppler in the apical five-chamber view reveals LR-shunting across a perimembranous VSD (same patient as in Video 3.3) Parasternal short-axis view at the level of the left ventricular outflow tract showing restriction of a perimembranous VSD due to accessory tricuspid valve tissue Video 3.6 Video 3.7 Video 3.8 Video Colour Doppler confirms LR-shunting across a perimembranous VSD despite accessory tricuspid valve tissue (same patient as in Video 3.5) Perimembranous VSD displayed in the parasternal long-axis view just underneath the aortic valve Colour in the parasternal long-axis view demonstrates LR-shunting across a rather large perimembranous defect located underneath the aortic valve (same patient as in Video 3.7) Large malalignment VSD with anterior deviation of the outlet septum in the parasternal shortaxis view. Colour Doppler shows acceleration of blood flow due to significant narrowing of the proximal right ventricular outflow tract Video 3.10 The parasternal long-axis view in this patient with malalignment VSD in the context of tetralogy of Fallot shows overriding of the aorta over the ventricular septum Video 3.11 Colour Doppler interrogation in the parasternal long-axis view in a patient with tetralogy of Fallot confirms flow across the malalignment VSD (same patient as in Video 3.10) Video 3.12 Colour Doppler in a sweep from the apical four-chamber view to the apical five-chamber view in a patient with tetralogy of Fallot. Despite its size, the large malalignment VSD is not apparent in the apical four-chamber view. It is well displayed following ventral tilt of the transducer to the apical five-chamber view, which clearly shows shunting from both ventricles into the overriding aorta Video 3.13 The subcostal RAO view in this patient with malalignment defect shows nicely the large defect and anterior deviation of the outlet septum Video 3.14 The subcostal short-axis view of the right ventricular outflow in a patient with tetralogy of Fallot shows severe obstruction of the right ventricular outflow tract due to anterior deviation of the outlet septum Video 3.15 The parasternal long axis (A) in this patient with perimembranous malalignment VSD shows posterior deviation of the outlet septum resulting in severe obstruction of the left ventricular outflow tract Video 3.16 Colour Doppler in the parasternal long-axis view of a patient with perimembranous malalignment VSD resulting in left ventricular outflow obstruction due to posterior deviation of the outlet septum fails to show significant acceleration of flow in the outflow tract (same patient as in Video 3.15)

4 416 Video 3.17 Perimembranous inlet VSD extending to the level of the AV valves. The inlet VSD is associated in this patient with overriding of the tricuspid valve annulus over the VSD. Furthermore, there is straddling of the tricuspid valve due to partial insertion of the valve apparatus in the left ventricle Video 3.18 Parasternal short-axis view at the level of the aortic valve depicts a doubly committed VSD, which extends both to the aortic valve and to the pulmonary valve Video 3.19 Colour Doppler in the parasternal long-axis view shows significant LR-shunting in a patient with large doubly committed VSD (same patient as in Videos 3.18, 3.20 and 3.21). There is almost no tissue between the defect and the pulmonary valve Video 3.20 The parasternal long-axis view in a patient with doubly committed VSD shows a defect that extends up to the level of the aortic valve (same patient as in Videos 3.18, 3.19 and 3.21) Video 3.21 Colour Doppler in the parasternal long-axis view in a patient with doubly committed VSD reveals significant LR-shunting across a large defect (same patient as in Videos 3.18, 3.19 and 3.20) Video 3.22 Apical four-chamber view in a 3-month-old infant with large perimembranous VSD. While the defect is not displayed in this imaging plane, significant enlargement of the left atrium and left ventricle suggests hemodynamic relevance of the defect due to significant LR-shunting Video 3.23 Colour Doppler in the parasternal short-axis view of the ventricles in a newborn shows LR-shunting due to a muscular inlet VSD. The posterior defect is localized in this view at 7 8 o clock Video 3.24 The same restrictive muscular inlet VSD is displayed by colour Doppler in the posterior view of the apical four-chamber view (same patient as in Videos 3.23, 3.25 and 3.26) Video 3.25 The parasternal short-axis view of the ventricles (same patient as in Videos 3.23, 3.24 and 3.26) reveals another muscular VSD, which is displayed at 2 3 o clock, characterizing it as anterior trabecular defect Video 3.26 Colour Doppler in the parasternal short-axis view shows significant shunting across this defect (same patient as in Videos 3.23, 3.24 and 3.25) Video 3.27 Colour Doppler in this parasternal short-axis view of the ventricle in a newborn depicts LR-shunting across a midventricular muscular VSD Video 3.28 The apical four-chamber view in a young infant shows a small midventricular muscular VSD Video 3.29 Colour Doppler in the apical four-chamber view shows LR-shunting and confirms the restrictive nature of this small midventricular muscular VSD (same patient as in Video 3.28) Video 3.30 Colour Doppler in the parasternal long-axis view reveals a small and restrictive midventricular muscular VSD in another infant Video 3.31 The apical four-chamber view in this newborn shows an apical muscular VSD with significant dilatation of the right atrium and right ventricle. Note redundant tissue of the atrial septum floating in the right atrium (same patient as in Video 3.32) Video 3.32 Colour Doppler in the apical four-chamber view (same patient as in Video 3.31) reveals bidirectional shunting across the apical VSD indicating systemic pressure in the right ventricle. Note also tricuspid regurgitation. Video 3.33 Colour Doppler in the parasternal short-axis view of the ventricles in a newborn reveals bidirectional, predominant RL-shunting across a large muscular anterior VSD. Predominant RL-shunting in this patient indicates elevation of pulmonary vascular resistance Video 4.1 Video 4.2 Video 4.3 Video 4.4 The apical four-chamber view of an infant with complete AVSD shows the primum ASD and the large VSD under the superior bridging leaflet of the common atrioventricular valve In this infant with transitional form of AVSD, the apical four-chamber view shows the primum ASD and two separate atrioventricular valve orifices. Separation of the atrioventricular valve is due to chordal attachments of the superior bridging leaflet to the crest of the ventricular septum The apical four-chamber view in this child shows an apparently normal atrioventricular connection (same patient as in Video 4.4). In the midportion of the atrial septum, there is an atrial septum aneurysm bulging from left to right The parasternal short-axis view in this patient (same patient as in Video 4.3) shows a cleft, representing the apposition zone of the superior and inferior bridging leaflet. This malfor-

5 Video 4.5 Video 4.6 Video 4.7 Video 4.8 Video 4.9 mation belongs to the spectrum of AVSD, although the patient has neither a primum ASD nor an inlet VSD. Contrary to isolated clefts, the cleft in this patient is oriented towards the left ventricular outflow tract and right ventricular inlet The apical four-chamber view in this 3-monthold infant shows a partial AVSD with a large primum ASD and significant right ventricular dominance (same patient as in Videos 4.6 and 4.7) Colour Doppler in the apical four-chamber view (same patient as in Videos 4.5 and 4.7) shows significant LR-shunting at atrial level and confirms hypoplasia of the left-sided atrioventricular valve and left ventricle Excessive right ventricular dominance and left ventricular hypoplasia are also evident in the parasternal short-axis view (same patient as in Videos 4.5 and 4.6) The parasternal long-axis view in an infant with complete AVSD shows elongation of the left ventricular outflow compared to the left ventricular inlet portion The sweep in the parasternal short-axis view of a child with AVSD shows the cleft in the leftsided atrioventricular valve representing the apposition zone of the superior and inferior bridging leaflet. Similar to the patient in Videos 4.3 and 4.4, this patient also has no significant defect in the atrial and ventricular septum Video 4.10 Colour Doppler in the parasternal short-axis view of an infant with complete AVSD shows two orifices in the left-sided atrioventricular valve representing the so-called double-orifice mitral valve Video 4.11 Video 4.12 The anterior plane of a subcostal coronal view shows the anterior bridging leaflet and the left ventricular outflow tract of an infant with complete AVSD. A large VSD can be visualized underneath the anterior bridging leaflet In an infant with complete AVSD, the subcostal LAO view displays the common atrioventricular valve with the superior and inferior bridging leaflets Video 4.13 In a patient with heterotaxy syndrome (right isomerism), the apical four-chamber view shows the large primum ASD and the common atrioventricular valve. The common atrioventricular valve is connected to a single ventricular chamber without apparent ventricular septum 417 Video 4.14 Colour Doppler in the apical four-chamber view of this infant with complete AVSD shows significant regurgitation of the left side of the common atrioventricular valve. Note there is some right ventricular dominance in the presence of a small left atrioventricular valve Video 4.15 Mild regurgitation of the left-sided atrioventricular valve in an infant with well-balanced complete AVSD is displayed by colour Doppler in this apical four-chamber view Video 4.16 Colour Doppler in the parasternal short-axis view of a patient with complete AVSD shows the large VSD with significant LR-shunting coded in red Video 4.17 The parasternal short-axis view in a patient with transitional form of AVSD shows the primum ASD. The ventricular septum is intact due to accessory tissue and adhesions of the right-sided atrioventricular valve (same patient as in Video 4.18) Video 4.18 Colour Doppler in the parasternal short-axis view confirms absence of shunting across the ventricular septum (same patient as in Video 4.17) Video 4.19 The parasternal short-axis view in another patient with transitional form of AVSD shows a small primum ASD, which is apparent preferentially in diastole. The ventricular septal defect is easily recognized in diastole, while it is at least partially closed by accessory tissue and adhesions of the right-sided atrioventricular valve in systole Video 4.20 The parasternal long-axis view in a 4-year-old child following corrective surgery of complete AVSD at the age of 5 months shows obstruction of the left ventricular outflow by a fibrous membrane proximal to the aortic valve (same patient as in Video 4.21) Video 4.21 Colour Doppler in the parasternal long-axis view confirms obstruction of the left ventricular outflow with acceleration of flow proximal to the aortic valve (same patient as in Video 4.20). In addition colour Doppler reveals minor regurgitation of the mitral valve Video 5.1 Video 5.2 The apical four-chamber view in a 12-monthold infant shows moderate dilatation of the left atrium and left ventricle which is explained by significant left to right shunting of a mediumsize ductus This colour Doppler sweep in an infant starts in the parasternal short-axis view of the pulmonary bifurcation. Cranial tilt of the transducer

6 418 Video 5.3 Video 5.4 Video 5.5 Video 5.6 Video 5.7 Video 5.8 Video 5.9 reveals significant inflow into the pulmonary artery from a patent ductus arteriosus. Further cranial tilt reveals connection of the ductus to the upper descending aorta A slightly oblique high parasternal short-axis view of a neonate displays the aorta in cross section and the pulmonary bifurcation. A large ductus arteriosus connects the pulmonary artery with the descending aorta. Colour Doppler reveals bidirectional shunting across the ductus arteriosus (RL-shunting during systole, LR-shunting during diastole) The ductal view (high left parasternal sagittal view) in a neonate shows a large ductus arteriosus connecting the pulmonary artery to the descending aorta. The aortic isthmus is without obstruction Colour Doppler in the ductal view shows significant LR-shunting across the ductus (same patient as in Video 5.4) The ductal view of a newborn with transposition of the great arteries shows a large ductus connecting the aorta with the pulmonary artery. Colour Doppler however reveals that shunting across the ductus arteriosus is limited by a fibrous membrane at the pulmonary end of the ductus, resulting in significant reduction of ductal diameter The ductal view in a 3-year-old child shows complete occlusion of a formerly medium-size ductus with an Amplatzer R duct occluder. The occluder protrudes slightly in the roof of the pulmonary artery, but there is no obstruction of the origin of the left pulmonary artery, which is located caudal to the occluder The ductal view in a newborn with pulmonary atresia and intact ventricular septum displays the finding following interventional stenting of the ductus arteriosus. The ductal stent is easily recognized and extends from the aortic isthmus to the pulmonary bifurcation covering the entire length of the ductus arteriosus Colour Doppler in the ductal view reveals patency of the stented ductus arteriosus (same patient as in Video 5.8) Video 5.10 The parasternal short axis in this infant shows diastolic inflow from the lateral wall of the main pulmonary artery. Since the inflow of this vessel has no connection to the pulmonary bifurcation, it does not represent a patent ductus arteriosus. Most likely this inflow is created by a small coronary artery fistula (which was confirmed at a later stage in this child by angiography) Video 5.11 Video 6.1 Video 6.2 Video 6.3 Video 6.4 Video 6.5 Video 6.6 Video 6.7 Video 6.8 Video 6.9 The ductal view in an infant shows a small vessel originating from the descending aorta with flow directed towards the pulmonary artery. This small vessel can be differentiated from a tiny patent ductus arteriosus, since it does not produce inflow into the lumen of the pulmonary artery. Therefore, it represents a small aortopulmonary collateral artery Apical four-chamber view in a 4-week-old patient showing significant enlargement of the left atrium and ventricle due to significant shunting of a large AP window. Note bulging of the atrial septum from left to right Colour Doppler in the apical four-chamber view in an infant with large AP window (same patient as in Video 6.1) shows enlarged pulmonary veins and increased flow to the left atrium (B) The parasternal short-axis sweep in a 7-weekold infant with medium-size intermediate AP window shows the defect located cranially to the level of the aortic valve and proximal to the bifurcation Parasternal short axis in a plane cranial to the aortic valve showing a large AP window between the aorta and pulmonary artery Colour Doppler in the parasternal short-axis view shows LR-shunting across a medium-size intermediate AP window (same patient as in Videos 6.3, 6.6 and 6.8). Shunting is apparent both in systole and in diastole; in diastole the jet extends down to the level of the pulmonary valve Colour Doppler in the parasternal short-axis view at the level of the bifurcation (same patient as in Videos 6.3, 6.5 and 6.8) confirms localization of the AP window proximal to the bifurcation In this infant with large distal-type AP window, the subcostal coronal plane shows the large defect between the aorta and pulmonary artery. In addition the infant has a perimembranous VSD located underneath the aortic valve Colour Doppler in the anterior plane of a subcostal coronal view showing a medium-size intermediate AP window (same patient as in Videos 6.3, 6.5 and 6.6) connecting the main pulmonary artery and aorta Colour Doppler in the suprasternal long-axis view of a patient with large AP window. Systolic blood flow in the distal aortic arch and aortic isthmus is accelerated and turbulent despite the absence of coarctation. Marked retrograde flow is present in the aortic arch and descending aorta due to diastolic run-off from the ascending aorta to the pulmonary artery

7 Video 7.1 Video 7.2 Video 7.3 Video 7.4 Video 7.5 Video 7.6 Video 7.7 Video 7.8 Video 7.9 Video 7.10 Video 7.11 Video 7.12 The apical four-chamber view in a neonate with critical pulmonary stenosis shows significant apical hypertrophy of the right ventricle. The atrial septum bulges in diastole from right to left Colour Doppler in the apical four-chamber view shows severe tricuspid regurgitation (same patient as in Video 7.1) Parasternal long-axis view of the right ventricular outflow tract in a neonate with severe pulmonary valve stenosis shows limited separation (doming) of the valve in systole Colour Doppler in the parasternal long-axis view of the right ventricular outflow tract (same patient as in Video 7.3) shows acceleration of flow in systole and minor pulmonary regurgitation in diastole The parasternal short-axis view in a neonate with critical pulmonary stenosis displays significantly thickened leaflets of the pulmonary valve resulting in severely restricted opening of the valve In a patient with Noonan syndrome and dysplastic pulmonary valve, the parasternal shortaxis view shows narrowing at the sinotubular junction. Although the valve was dysplastic and thickened (proven by angiocardiography), this finding is not demonstrated by echocardiography Colour Doppler in the parasternal short-axis view (same patient as in Video 7.6) shows turbulence and significant acceleration of flow starting at valvular level The high left parasternal short-axis view in a newborn with stenotic bicuspid pulmonary valve shows thickening and incomplete separation of the valve leaflets Significant thickening of the valve leaflets in the setting of a tricuspid pulmonary valve is present in this neonate with critical pulmonary stenosis Colour Doppler in the parasternal short-axis view at the level just below the aortic valve in a child with double-chambered right ventricle shows obstruction due to anomalous muscle bundles well below the pulmonary valve Obstructing anomalous muscles in an adolescent with double-chambered right ventricle are well displayed in the parasternal short-axis view at the level of the aortic valve (same patient as in Video 7.10) Colour Doppler in the subcostal coronal view shows significant obstruction due to anomalous muscle bundles well below the pulmonary valve in this child with double-chambered right ventricle 419 Video 7.13 Colour Doppler in the parasternal short-axis view at the level of the pulmonary bifurcation in a neonate with tetralogy of Fallot shows severe stenosis at the origin of the left pulmonary artery due to narrowing by ductal tissue Video 7.14 Colour Doppler in the parasternal short-axis view in an infant with Williams-Beuren syndrome shows turbulence and acceleration of flow in the right pulmonary artery due to stenosis of the pulmonary bifurcation Video 7.15 Colour Doppler in the subcostal coronal view of the right ventricular outflow tract in a newborn with critical pulmonary valve stenosis shows significant obstruction and acceleration of flow at valvular level Video 7.16 Colour Doppler in the parasternal long-axis view of the right ventricular outflow tract shows minor amount of physiological pulmonary regurgitation in a 4-year-old child with normal cardiovascular findings Video 7.17 Colour Doppler in the subcostal RAO view of a child with combined pulmonary stenosis and regurgitation shows acceleration of flow during systole due to obstruction at valvular level and significant pulmonary regurgitation directed towards the transducer in diastole. Note the dilated central pulmonary arteries Video 7.18 Colour Doppler in the parasternal short-axis view of the pulmonary bifurcation shows reverse flow in the main and central pulmonary arteries indicating severe pulmonary regurgitation in a 3-year-old child following repair of tetralogy of Fallot. Pulmonary regurgitation in this case can be explained by surgical correction with a transannular patch Video 8.1 Video 8.2 Video 8.3 Video 8.4 Video 8.5 Apical four-chamber view in a neonate with PAiVS and severely hypoplastic right ventricle and tricuspid valve Colour Doppler in the apical four-chamber view (same patient as in Video 8.1) shows diastolic antegrade flow (coded red) confirming patency of the hypoplastic tricuspid valve Parasternal short-axis view at the level of the aortic valve in a newborn shows patency of the right ventricular outflow tract up to the level of the atretic pulmonary valve Colour Doppler in the parasternal short-axis view (same patient as in Video 8.3) shows retrograde flow in the main pulmonary artery originating from the patent ductus arteriosus The colour Doppler sweep from the suprasternal notch in a neonate with PAiVS and wellformed tripartite right ventricle starts with the

8 420 Video 8.6 Video 8.7 Video 8.8 Video 8.9 Video 8.10 Video 8.11 Video 8.12 long-axis view of the aortic arch. Leftward tilt of the transducer reveals a large ductus arteriosus connecting to the pulmonary bifurcation The suprasternal long-axis view of the aortic arch in a patient with PAiVS and unipartite, hypoplastic right ventricle shows a tortuous ductus arteriosus originating with an acute angle from the undersurface of the arch Colour Doppler in the parasternal short-axis view of the aortic root shows the left coronary artery in a newborn with PAiVS and hypoplastic right ventricle. Note significant enlargement of the coronary artery at its origin from the aorta. Due to right ventricular coronary artery connections, the left coronary artery exhibits retrograde flow directed towards the aorta in systole (displayed in blue), while there is regular antegrade coronary flow (displayed in red) during diastole Apical four-chamber view in a newborn with PAiVS and tripartite right ventricle shows dilated right atrium and reasonable size right ventricle and tricuspid valve Colour Doppler in the apical four-chamber view (same patient as in Video 8.8) reveals moderate regurgitation of a normal-size mitral valve In this patient with PAiVS and dysplastic tricuspid valve, the right atrium is grossly dilated Colour Doppler in the apical four-chamber view reveals that dilatation of the right atrium can be attributed to severe tricuspid regurgitation Colour Doppler in the parasternal long-axis view of the right ventricular outflow shows retrograde flow in the main pulmonary artery directed towards the atretic pulmonary valve Video 8.13 Colour Doppler in a tilted apical four-chamber view of a newborn with PAiVS and moderately hypoplastic right ventricle shows apical in- and outflow due to a ventriculo-coronary communication Video 8.14 Video 9.1 In- and outflow phenomena in the right ventricle are also apparent in the tilted parasternal short-axis view of another newborn with PAiVS, hypoplastic right ventricle and ventriculo-coronary communications The apical four-chamber view in a newborn with tricuspid atresia and absent right atrioventricular connection shows fibro-fatty tissue interposed between right atrium and right ventricle connection. The large left ventricle is connected with the hypoplastic right ventricle by a VSD Video 9.2 Video 9.3 Video 9.4 Video 9.5 Video 9.6 Video 9.7 Video 9.8 Video 9.9 Video 9.10 Colour Doppler in the four-chamber view shows absence of flow across the tricuspid valve in diastole, while there is turbulent flow from the left ventricle to the right ventricle across the VSD in systole (same patient as in Video 9.1) The parasternal long-axis view in a patient with tricuspid atresia and normal connection of the great arteries shows origin of the aorta from the left ventricle. The hypoplastic right ventricle is connected to the left ventricle by a large VSD Parasternal short-axis view of the base of the heart in a neonate with tricuspid atresia shows absent connection of the right atrium and right ventricle. The hypoplastic right ventricle is connected to the pulmonary artery Colour Doppler in the parasternal short-axis view of the base of the heart (same patient as in Video 9.4) shows acceleration of flow due to a small restrictive VSD and obstruction of flow in the midportion of the hypoplastic right ventricle. Note continuous flow in the main pulmonary artery in the presence of a large ductus arteriosus The apical four-chamber view in a newborn with tricuspid atresia, normal connection of the great arteries and large unrestrictive VSD shows absent right atrioventricular connection. Left atrium and left ventricle are significantly enlarged due to excessive pulmonary blood flow Colour Doppler in the apical four-chamber view (same patient as in Video 9.6) shows significantly increased flow in the pulmonary veins and left atrium confirming excessive pulmonary blood flow The parasternal long-axis view in a newborn with tricuspid atresia and ventriculoarterial discordance shows origin of the large pulmonary artery from the left ventricle, while the smaller aorta originates anterior from the right ventricle (same patient as in Videos 9.9 and 9.10) The sweep in a more cranial position (same patient as in Videos 9.8 and 9.10) shows transition of the anterior ascending aorta to a hypoplastic aortic arch. Pulmonary artery and aorta are connected by a large ductus arteriosus Colour Doppler in the suprasternal long-axis view (same patient as in Videos 9.8 and 9.9) shows hypoplasia of the aortic arch distal to the innominate artery. Some acceleration of

9 Video 9.11 Video 9.12 Video 9.13 Video 9.14 Video 9.15 Video 10.1 Video 10.2 Video 10.3 flow is found distal to the left subclavian artery. At that time the ductus arteriosus was small and restrictive Subcostal short-axis view in a neonate with tricuspid atresia shows the unobstructed pulmonary artery origination from the right ventricle, which is connected to the left ventricle via a large VSD Colour Doppler in the subcostal short-axis view (same patient as in Video 9.11) confirms unobstructed flow across the large VSD and right ventricular outflow tract in a patient with tricuspid atresia and normal connection of the great arteries In a newborn with restrictive VSD, colour Doppler in the subcostal short-axis view reveals accelerated and turbulent flow both across the VSD and in the hypoplastic right ventricle The subcostal short-axis view in this newborn with tricuspid atresia and ventriculoarterial discordance shows origin of the aorta from the right ventricle and the parallel course of the aorta and enlarged pulmonary artery Right to left shunting across the patent foramen ovale is displayed by colour Doppler in the subcostal short-axis view of the atria in a newborn with tricuspid atresia. Normal inflow from the superior vena cava into the right atrium (directed towards the transducer) is displayed in red The apical four-chamber view in a neonate with Ebstein s malformation shows severe displacement of the tricuspid valve from the plane of the atrioventricular junction. The plane of the effective tricuspid valve orifice is not displayed in this view. A central line is floating in the right atrium, and the atrial septum with an atrial septal aneurysm is bulging into the left atrium Colour Doppler in the apical four-chamber view shows inflow across the tricuspid valve (same patient as in Video 10.1). Tricuspid regurgitation is not apparent in this view but cannot be assessed with certainty, since the tricuspid valve orifice is not displayed due to its apical displacement In this newborn the apical four-chamber view shows adherence and apical displacement of the severely dysplastic septal tricuspid valve leaflet. The anterior leaflet is large and restricted in its mobility due to mural attachments. Both right atrium and right ventricle are enlarged Video 10.4 Video 10.5 Video 10.6 Video 10.7 Video 10.8 Video Colour Doppler in the apical four-chamber view (same patient as in Videos 10.3 and 10.5) reveals severe tricuspid regurgitation The sweep in the parasternal long-axis view (same patient as in Videos 10.3, 10.4 and 10.6) shows severe dilatation of the right ventricle in the plane of the left ventricular outflow tract. Rightward tilt of the transducer to the parasternal long-axis view of the right ventricular inflow shows significant displacement of the posterior leaflet of the tricuspid valve from the atrioventricular junction and the coronary sinus towards the apex of the right ventricle Significant displacement of the posterior leaflet of the tricuspid valve is well recognized in the parasternal long-axis view of the right ventricular inflow (same patient as in Videos 10.3, 10.4, 10.5 and 10.7). This is the most important plane to assess the posterior leaflet of the tricuspid valve Colour Doppler in the parasternal long-axis view of the right ventricular inflow (same patient as in Videos 10.3, 10.4, 10.5 and 10.6) confirms apical displacement of the effective tricuspid valve orifice and reveals moderate tricuspid valve regurgitation Significant apical displacement of the posterior tricuspid valve leaflet from the tricuspid annulus is apparent in the subcostal coronal view in a neonate with severe Ebstein s anomaly Significant displacement is also apparent in the subcostal RAO view (same patient as in Video 10.8). This plane also shows the large anterior tricuspid valve leaflet Video The parasternal short-axis view in this neonate with Ebstein s anomaly shows a large anterior tricuspid valve leaflet with attachments to the anterior wall of the right ventricle Video Colour Doppler in the parasternal short-axis view (same patient as in Video 10.10) shows unobstructed flow from the right ventricle to the pulmonary artery despite diastolic protrusion of the anterior tricuspid valve leaflet into the right ventricular outflow tract. Note diastolic inflow into the pulmonary artery via a small restrictive patent ductus arteriosus Video 11.1 The parasternal long-axis view in this infant with tetralogy of Fallot shows the large perimembranous malalignment VSD and overriding of the aorta

10 422 Video 11.2 Video 11.3 Video 11.4 Video 11.5 Video 11.6 Video 11.7 Video 11.8 The sweep in the parasternal long axis from the plane of the left ventricular outflow to the plane of the right ventricular outflow (same patient as in Video 11.1) shows anterior deviation of the outlet septum resulting in subvalvular obstruction of the right ventricular outflow tract Colour Doppler in the sweep from the parasternal long-axis view of the left ventricular outflow to the plane of the right ventricular outflow tract (same patient as in Videos 11.1 and 11.2) shows acceleration of flow starting well below the level of the pulmonary valve The parasternal short-axis view in this infant with tetralogy of Fallot (same patient as in Videos 11.1, 11.2 and 11.3) nicely shows the large perimembranous malalignment VSD, anterior deviation of the outlet septum and the resulting subvalvular right ventricular outflow tract obstruction Colour Doppler in the apical four-chamber view shows an intact ventricular septum in the plane of the atrioventricular valves. Anterior sweep of the transducer reveals the large VSD and overriding of the aorta, which receives flow both from right and left ventricles Parasternal short-axis sweep in an infant with tetralogy of Fallot. The sweep starts at the level of the papillary muscles. Cranial tilt of the transducer reveals the large perimembranous malalignment VSD, anterior deviation of the outlet septum and infundibular stenosis of the right ventricular outflow tract The parasternal short-axis view at the level of the aortic valve shows nicely infundibular obstruction resulting from anterior deviation of the outlet septum In this newborn the parasternal short-axis view at the level of the aortic valve shows severe infundibular obstruction resulting from anterior deviation of the outlet septum. In addition the pulmonary valve is severely stenotic Video 11.9 Colour Doppler in the parasternal short-axis view (same patient as in Video 11.8) reveals only minimal antegrade flow across the pulmonary valve Video The parasternal short-axis view at the level of the aortic valve in a newborn with tetralogy of Fallot shows restriction of the large VSD by redundant accessory tricuspid valve tissue Video The parasternal short-axis view of the pulmonary bifurcation in a newborn with tetralogy of Fallot shows small central pulmonary arteries Video Colour Doppler short-axis view from a high parasternal window in a newborn with tetralogy of Fallot. Cranial tilt of the transducer displays the innominate vein, coursing cranial to the aorta, connecting to the superior vena cava. Clockwise rotation of the transducer opens the right aortic arch of this patient Video Colour Doppler in the high parasternal shortaxis view in this patient with tetralogy of Fallot and right aortic arch (same patient as in Video 11.12) reveals that the first brachiocephalic vessel courses to the left representing a left innominate artery branching into left subclavian and left common carotid artery Video Suprasternal long-axis view of the aortic arch in a newborn with tetralogy of Fallot shows origin of a long and tortuous ductus arteriosus from the undersurface of the aortic arch Video Colour Doppler interrogation (same patient as in Video 11.14) confirms left to right shunting across the ductus with acceleration of flow at its pulmonary end Video The subcostal short axis view in this neonate with tetralogy of Fallot shows significant obstruction at infundibular level due to anterior deviation of the outlet septum Video Colour Doppler (same patient as in Video 11.16) confirms obstruction by acceleration of flow and turbulence in the right ventricular outflow tract Video The RAO view in this newborn with tetralogy of Fallot shows the large VSD and anterior deviation of the infundibular (outlet) septum. Despite its anterior deviation, the outlet septum does not cause subvalvular obstruction in this patient Video The parasternal short-axis view at the level of the main pulmonary artery and bifurcation in a newborn with tetralogy of Fallot and absent pulmonary valve shows dysplastic nodules instead of a normal pulmonary valve. Note the pathognomonic severe dilatation of the main and central pulmonary arteries Video Colour Doppler in the parasternal short-axis view (same patient as in Video 11.19) reveals both accelerated and turbulent antegrade flow in systole and severe pulmonary regurgitation in diastole Video Colour Doppler in the parasternal short-axis view of an infant with tetralogy of Fallot confirms significant acceleration of flow starting

11 Video 12.6 Video 12.7 Video 12.8 at infundibular level, where the anteriorly deviated outlet septum approaches the anterior wall of the right ventricle. Note laminar flow across the large perimembranous malalignment VSD Video Colour Doppler in the parasternal short-axis view of a 2-month-old infant with tetralogy of Fallot shows somewhat small central pulmonary arteries without obstruction at the bifurcation. Continuous inflow close to the origin of the left pulmonary artery is due to a small ductus arteriosus Video 12.1 Colour Doppler in the apical four-chamber view in an infant with tetralogy of Fallot and pulmonary atresia shows an intact ventricular septum in the plane of the atrioventricular valves. Anterior sweep of the transducer reveals the large VSD and overriding of the aorta, which receives flow both from right and left ventricles Video 12.2 The parasternal long-axis view in a newborn with pulmonary atresia and VSD shows the large perimembranous VSD and overriding of the aorta Video 12.3 Colour Doppler in the parasternal long-axis view (same patient as in Video 12.2) nicely shows flow from both the right and left ventricles entering the aorta Video 12.4 Colour Doppler in the apical five-chamber view of an infant with PA-VSD displays the large malalignment VSD and flow from both ventricles reaching the aorta Video 12.5 The large malalignment VSD and overriding of the aorta are also documented in the subcostal coronal view of a newborn with PA-VSD Parasternal short-axis view at the level of the pulmonary bifurcation in a newborn with PA-VSD shows the pulmonary bifurcation with a blind-ending main pulmonary artery The high parasternal short-axis view in a newborn with PA-VSD and collateral lung perfusion by MAPCAs displays extremely hypoplastic central pulmonary arteries behind the ascending aorta, which is displayed in cross section Colour Doppler confirms in the extremely hypoplastic central pulmonary arteries (same patient as in Video 12.7). Retrograde flow in the left pulmonary artery is explained by the fact that one of the MAPCAs connected to the left pulmonary artery in the hilus of the left lung Video Suprasternal long-axis view of the aortic arch in a newborn shows origin of a long and tortuous ductus arteriosus from the undersurface of the aortic arch. The tortuous course of the ductus arteriosus is typical for patients with obstruction of pulmonary blood occurring early during cardiac development Video Colour Doppler confirms left to right shunt across the ductus arteriosus (same patient as in Video 12.9) with acceleration of flow due to ductal constriction at the pulmonary end Video Colour Doppler sweep in a newborn with PA-VSD, right aortic arch and left-sided ductus arteriosus, originating from the base of the left innominate artery. The sweep starts in the high parasternal short-axis view of the pulmonary bifurcation showing well-formed central pulmonary arteries. Cranial tilt of the transducers exhibits a large and tortuous leftsided ductus arteriosus connecting to the pulmonary bifurcation. Further cranial tilt reveals origin of the ductus from the left innominate artery confirming the presence of a right aortic arch Video Colour Doppler sweep from the suprasternal long-axis view of the aortic arch in a newborn with PA-VSD and collateral lung perfusion provided by MAPCAs. A tortuous MAPCA originates from the upper descending aorta which takes a course to the right lung. A second MAPCA originates a little bit more caudal from the descending aorta (same patient as in Videos and 12.14) Video Colour Doppler interrogation in the suprasternal short-axis view allows to follow the MAPCA to the right lung quite distally (same patient as in Videos and 12.14) Video Colour Doppler in the suprasternal short-axis view displays another MAPCA, which clearly divides into two branches (same patient as in Videos and 12.13) Video Colour Doppler in the subcostal short-axis view of the descending aorta shows a large MAPCA originating from the midportion of the descending aorta just above the level of the left atrium Video The parasternal short-axis view of the aortic root in this newborn with PA-VSD and MAPCAs reveals a significantly dilated left coronary artery, which takes a tortuous course towards the right ventricular outflow tract

12 424 Video Colour Doppler confirms antegrade systolic flow in the dilated left coronary artery (same patient as in Video 12.16) Video 13.1 Parasternal long-axis view in a newborn shows the large perimembranous malalignment VSD and overriding of the truncus arteriosus. The truncal valve is slightly dysplastic. Cranial to the truncal valve, the pulmonary artery originates from the posterior truncal wall Video 13.2 Colour Doppler in the parasternal long-axis view (same patient as in Video 13.1) shows flow from both ventricles entering the truncus arteriosus. Systolic flow across the truncal valve is accelerated and turbulent. Truncal valve regurgitation directed towards the right ventricle is evident in diastole Video 13.3 The large perimembranous VSD and overriding of the truncal valve are displayed in the apical five-chamber view of a newborn with truncus arteriosus Video 13.4 The apical four-chamber view in the plane of the atrioventricular valves shows a seemingly intact ventricular septum in a young infant with truncus arteriosus. Note the enlarged left atrium and left ventricle which is due to increased pulmonary blood flow Video 13.5 In a newborn with truncus arteriosus, the parasternal short-axis sweep starting at the level of the papillary muscles reveals the large perimembranous malalignment VSD, which is Video 13.6 Video 13.7 Video 13.8 Video 13.9 located underneath the truncal valve The parasternal short-axis sweep starting at the level of the truncal valve (same patient as in Video 13.5) displays a tricuspid truncal valve. Both pulmonary arteries originate very close from the posterior wall of the truncus arteriosus (truncus arteriosus type A2) Colour Doppler in the parasternal short-axis view (same patient as in Video 13.6) confirms unobstructed origin of the pulmonary arteries from the truncus arteriosus Colour Doppler in the parasternal short-axis view of a newborn with truncus arteriosus type A3 reveals origin of the right pulmonary artery from the posterior truncal wall. The left pulmonary artery is displayed by colour Doppler but does not connect to the main pulmonary artery (see also Videos 13.9 and 13.10) Colour Doppler in the high left parasternal short-axis view reveals a left innominate artery dividing into left common carotid and left subclavian artery suggesting a right aortic arch (same patient as in Videos 13.8 and 13.10). From the base of the innominate artery originates a left ductus arteriosus, which supplies the left pulmonary artery (see Video 13.8) Video Colour Doppler in the suprasternal long-axis view (same patient as in Videos 13.8 and 13.9) confirms a right aortic arch Video The high right parasternal long-axis view of the aortic arch in a patient with truncus arteriosus type A2 displays posterior origin of the right pulmonary artery from the arterial trunk Video The colour Doppler sweep in a patient with truncus arteriosus type A4 starts in a high parasternal sagittal plane. Leftward orientation of the transducer displays origin of both pulmonary arteries from the posterior wall of the truncus arteriosus; the large cranial structure is a huge patent ductus arteriosus. Rightward orientation of the transducer displays the ascending aorta originating from the truncus arteriosus. At the end of the sweep, the transducer is tilted again towards the left, displaying the ductus and the origin of the pulmonary arteries Video The high parasternal short-axis view in a patient with truncus arteriosus type A4 shows separation of the common trunk into a small ascending aorta, which is located slightly anterior, and a large pulmonary artery. The innominate vein is visualized anterior the truncus arteriosus Video Colour Doppler in a slightly more cranial view (same patient as in Video 13.13) displays origin of the right and left pulmonary artery from the posterior aspect of the truncus arteriosus Video Colour Doppler in the oblique high parasternal short-axis view in a patient with TAC type A4 and interrupted aortic arch shows continuation of the large ductus arteriosus into the descending aorta (same patient as in video 13.12) Video The subcostal coronal view in this neonate with TAC type A1 shows the truncus arteriosus overriding both ventricles and the large VSD Video Colour Doppler in the subcostal coronal view (same patient as in Video 13.16) reveals systolic acceleration of flow across the truncal valve, while there is only minor regurgitation displayed in diastole Video The sweep in the subcostal coronal view of a newborn with TAC type A2 displays origin of the right pulmonary artery from the posterior aspect of the truncus arteriosus, while the left pulmonary artery takes its origin from the more leftward aspect of the truncus arteriosus